Acetaminophen Overdose. I have been a physician assistant for 20 years. During that time I have found that knowing information, being able to recall information and appropriately applying this information in a clinical setting were the cornerstone of efficiency with good patient outcome. I have presented information in these videos that you need to know. By repeatedly watching these short videos you are reinforcing the power and effectiveness of repetition. In no time the information will be riveted in your brain and you will begin to see with the eyes of your mind. You will evolved into a marketable, knowledgeable and efficient provider and most of all, patients will benefit from your commitment to knowledge. After all, residency in a nut shell is repetition for 4 years . Please check out all the videos that are uploaded.
Today i want to talk with you about acetaminophen overdose jim is a 30 year old bank manager who was rushed to the emergency department by his brother after he swallowed 25 tylenol pills 500 milligrams each presently he is alert and oriented times three nauseous and vomited twice with abdominal cramps his vitals are normal he’s connected to the cardiac monitor
And iv access has been attained what is the first thing i want to know the first thing i want to know is the time of ingestion the time of ingestion will determine how i proceed with the management if the time of ingestion is under two hours then activated charcoal may be given if the time of ingestion is beyond two hours then activated charcoal may not be as
Beneficial activated charcoal prevents the absorption of acetaminophen from the gut keep in mind that activated charcoal can induce vomiting resulting in aspiration an ekg is performed which showed normal sinus rhythm which labs should i order i’m gonna order the cbc complete metabolic profile ptptt acetaminophen level aspirin level alcohol and toxicology ideally
The acetaminophen level should be drawn four hours after ingestion so if an acetaminophen level is drawn on arrival then one should be done four hours after ingestion liver damage starts to occur after four hours what time should treatment be started on this patient treatment should be started after the acetaminophen level is known i gave him an acetylcysteine
Intravenously because he was vomiting given the medication intravenously is preferred over oral due to vomiting the loading dose is 150 milligrams per kg in 200 ml of d5 um w infused over 60 minutes the maintenance dose is 50 milligram per kg in 500 ml d5w over four hours and this is followed by a hundred milligram per kg in one liter of d5w infused over 15
Hours it is now 5 hours after ingestion its serum level is 200 that is a serum acetaminophen level is 200 milligram per liter the paracetamol normal graph shows that jim is in the toxic zone here’s the picture jim’s level at five hours is definitely in the toxic zone jim is receiving intravenous and acetylcysteine he remained stable and was admitted to the
Unit what is supratherapeutic ingestion supratherapeutic ingestion is a situation in which a person will constantly self-medicate with tylenol frequently until they reach a point of overdose in cases like this and acetylcysteine can be started immediately on arrival without waiting for a tylenol level in closing emergency providers should be mindful of the
Following number one the time of ingestion number two the amount of ingestion if possible number three tylenol level before treatment in willful overdose next treatment may be started immediately in supra therapeutic overdose then determine if liver damage has begun hold activated charcoal if ingestion is beyond two hours and be aware of the complication of
Aspiration and of course report the incident to poison control well thanks for watching please remember to like share and subscribe i wish you well good night
Transcribed from video
Acetaminophen Overdose By Norman’s Student Corner
